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from several of the causes listed. They rank first in deaths from scarlet fever and second in deaths from diphtheria and diphtheria and croup.

No other nationality has a consistent or striking rank according to cause of death. Even for the group whose mothers were born in the United States there are higher death rates from the acute infections than for a number of the other nationalities. With respect to the hazards of these diseases, one may parody the inquiry, "Does it pay to be healthy," by asking, "Does it pay to be native born?"

The fact that pneumonia, respiratory diseases-except tuberculosis-and the acute infections seem to play so fatal a part in the lives of the Italians in the United States, provides a practical point of attack for those who would lower general death rates among these foreign-born Americans and their children.

TUBERCULOSIS

The Irish are conspicuous in tuberculosis statistics by reason of their exceedingly high death rate from this dis`ease (Table XV). Russia and Poland again stand at the foot of the list, having a death rate from consumption more than a third less than that of the United States, which in turn is the lowest of any nationality but one. This low mortality, if not immunity, from the great scourge of tuberculosis, is a fact to be remembered in health work with the Jews. It will be seen that the death rate among the Irish is more than three times that of those whose mothers were born in the United States, and almost twice that of any other race.

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TABLE XV

DEATH RATE OF WHITES FROM CONSUMPTION, PER 100,000 POPULATION OF REGISTRATION AREA, 19001

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Guilfoy speaks of the fact of high mortality of the Irish in his article on the influence of nationality on mortality in New York City.2

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The death rate at all ages from pulmonary tuberculosis is noteworthy by reason of the excessively high rate among the Irish males; 701 out of every 100,000 died as compared with 333 native males

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Dr. Donald B. Armstrong, in the course of the tuberculosis experiment conducted during the past three years in Framingham, Massachusetts, found the same excessive death rate for this race.3 Analysis of

1 Twelfth Census of the U. S., 1900, Vital Statistics, vol. iii, p. lxxxviii.

2 William H. Guilfoy, M.D., "The Influence of Nationality upon the Mortality of a Community," New York City Department of Health, Monograph Series No. 18, November, 1917, pp. 20–21. "Vital Statistics," Sanitary Series No. 1, Framingham Monograph No. 3, Appendix A, Tables IV and XIII.

his data shows that although the Irish stock represents only 16.5 per cent of the population, they supplied 28 per cent of the deaths from tuberculosis for 1907-16. He also points to the low death rate of the Russians (Jews) in Framingham.

In Table XV the death rate from tuberculosis of the Italians is 113.6. This figure is about that of the native born, and is fourth lowest in the scale for all nationalities. The low death rate from tuberculosis of the Italians is brought out in other studies. In the Framingham study mentioned above, Italians represent 7.7 per cent of the residents, and only 5 per cent of the deaths from tuberculosis.

This fact seems particularly remarkable in view of the extremely high Italian death rate from diseases of the respiratory system, noted in Table XI, Chapter II, and Table XIV of this chapter. One supposition is that the Italian goes back to Italy as soon as he learns that he has tuberculosis. Many doctors interviewed by the study testified to this fact. Stella states that of 81,412 Italians returning to Italy in 1906, about 450, or 5.61 per 1,000, were advanced cases of this disease.1 When the Italian, particularly the southern Italian, falls ill with tuberculosis, memories of the home people and of sunny hills seem to pull him back with irresistible force to die in Italy. Such considerations, impossible of statistical classification, may account for many of the figures. In summarizing the scattered data presented in this chapter

1 Antonio Stella, M.D., "The Effects of Urban Congestion on Italian Women and Children," New York Medical Record, May 2, 1908.

we shall see how they relate to the principal racial groups.

HIGH MORTALITY OF THE IRISH

From data in the earlier part of the chapter the high death rate of the Irish was apparent. In the census figures of 1900, and in later figures for both New York State and city, this race stands consistently first among nationalities ranged in order of mortality rates. This rank is the more striking because the rates are about twice as large as comparable figures in Ireland. What elusive influences play upon this race as it is transplanted to another land, it is difficult to discover. A closer picture of conditions can be obtained from the figures on causes of death.

Alcoholism, as a cause of death among the Irish, is the outstanding feature of Table XIII. This race also takes primary rank in deaths from other diseases, such as Bright's disease, those of the digestive system, the circulatory and respiratory systems, as shown in Tables XIII and XIV. Ireland heads the death rates from consumption, showing a rate almost twice that of the next nearest figure, as seen in Table XV. In Doctor Davis's study of mortality in Boston, referred to above, the same excessive mortality of the Irish was noted.

Whether there is a relation between the high figure on alcoholism and susceptibility to these diseases is problematical. At least, their coincidence is suggestive. Since the Eighteenth Amendment to the United States Constitution has been passed, another decade may throw more light on these conditions. Less outstanding, but equally to be noted, is the comparatively

low rank (Table XIV) the Irish hold in deaths from the acute infections. Here they consistently show a lower rate than the native born. This, too, is a fact to be held in mind in considering racial differences.

LOW MORTALITY OF RUSSIANS

In contrast to the mortality rate of the Irish we find that of the Russians at the bottom of the list. They rank low in the census data for 1900, when they are classified with the Poles; they are found at the bottom of the table for New York City, and rank among the lowest in the table for New York State. The Russians include a large proportion of Jews (about half of all the Russians in the United States in 1910 were Jews, and in New York City the proportion is much larger), and Jews generally show a lower mortality rate than any nationality among which they live. Whatever may be the explanation of this fact, it accounts for the figures here presented.

In the tables showing causes of death the Russians do not maintain a fixed relation to the other nationalities. They are found at the foot of the list for the so-called degenerative diseases, showing in each case a lower rate than the native born (Table XIII). For the respiratory diseases they rank fifth in each case. To the acute infections they show a much higher susceptibility.

It is hard to trace this high mortality to any measurable factor. Such explanations as congested and unsanitary living conditions are at best mere surmises. The strikingly low death rate from tuberculosis, which is about a third less for these people than for

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